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Melasma. Why most clinics get this wrong.

Hormonally driven. Heat-sensitive. Easily worsened by aggressive laser. Melasma needs a different protocol to sun damage, and many Australian clinics still treat it the same way. Here is what works, what to avoid, and where to go.

What it is.

Melasma is a chronic acquired hyperpigmentation, most often presenting as symmetric brown or grey-brown patches across the cheeks, forehead, upper lip and jawline. It is hormonally driven (oral contraceptives, pregnancy, HRT) and exacerbated by heat, UV, and visible light, not just UV. It primarily affects Fitzpatrick III-V skin. Unlike solar lentigines, melasma sits across multiple skin layers and behaves differently to light-based treatment.

What works.

The evidence-backed topical pathway, ranked from foundational to advanced. Every product link goes to the full Glow review or category ranking.

Tinted SPF50+ with iron oxides

Mineral SPF with iron oxides blocks visible blue light, which triggers melasma. Generic chemical SPF alone is insufficient. La Roche-Posay Anthelios Mineral Tinted SPF50+ is the editorial default.

Tranexamic acid, topical 2-3%

Inhibits the plasminogen pathway upstream of melanin production. Sentry pharmaceutical formulations or compounded by a dermatologist. Mesoestetic Cosmelan Maintenance Cream is the leading retail option.

Cosmelan Method (in-clinic + home)

The Mesoestetic Cosmelan two-phase protocol (in-clinic mask + 6-month home program) is the most studied non-laser melasma treatment globally. Typically AU$800-1,400 for the initial protocol. Available at most Glow Recommended clinics.

Oral tranexamic acid

Prescription only, typically 250mg twice daily, under dermatology or GP supervision. Most studied oral systemic for melasma.

Azelaic acid 15-20%

Tolerable, evidence-based, useful as the daily-driver active in a melasma routine. Paula's Choice 10% Azelaic Acid Booster is the cleanest retail option.

What doesn't.

Glow's banned list

Aggressive BBL or IPL on active melasma. Heat worsens melasma. Most reputable BBL clinics will refuse to treat active melasma.
Hydroquinone unsupervised beyond 12 weeks. Rebound and ochronosis risk in chronic use.
Generic 'brightening' creams without tranexamic acid, azelaic acid or proven actives.
Sun exposure of any kind without strict mineral SPF. Even brief incidental sun darkens melasma within hours.
Hot showers, saunas, sun beds. Heat is a melasma trigger independent of UV.

When to see a clinic.

Cosmelan is the first-line in-clinic protocol for moderate-to-severe melasma. Most Glow Recommended clinics offer it. Skinologie and Clinica Lase both run Cosmelan; the latter also offers Pico Genesis FX for refractory cases on darker Fitzpatrick types. Flawless Rejuvenation is appropriate when the case is complex enough to need a doctor-led multi-modal plan combining topical, peel and possibly oral tranexamic acid under Dr Sean Arendse's supervision.

Questions, answered.

Is melasma the same as sun damage?

No. Sun damage is discrete sun spots on sun-exposed surfaces. Melasma is diffuse, often symmetric, hormonally driven, frequently worsens with heat, and primarily affects Fitzpatrick III-V skin. The treatment protocols are different.

Can BBL treat melasma?

Generally no. BBL is contraindicated for active melasma because the heat component can worsen the condition. Most reputable BBL clinics will refuse to treat active melasma and recommend Cosmelan or tranexamic acid pathways instead.

Will melasma go away on its own?

Sometimes, particularly post-pregnancy. Often it persists indefinitely without active treatment. Even after successful treatment, it returns with UV exposure, heat, or hormonal triggers.

Is Cosmelan worth the cost?

For moderate-to-severe melasma where topicals alone have not delivered results, Cosmelan is the most studied non-laser pathway and worth the AU$800-1,400 initial outlay. Success depends heavily on strict 6-month home maintenance and aggressive sun avoidance.

What is the relationship between melasma and the contraceptive pill?

Oestrogen and progestin in oral contraceptives can trigger or worsen melasma in genetically susceptible women. Discussion with a GP about whether to continue, switch, or pause hormonal contraception is part of any serious melasma protocol.